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Monday Morning Update 1/25/16

January 24, 2016 News 14 Comments

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The hacker group Anonymous is presumed to be behind a cyberattack against Flint, MI-based Hurley Medical Center, with the group apparently following through on its threats from the previous day to take action against those involved in the city’s water crisis. The hospital says its IT team detected the attack and reports no impact on operations.

Meanwhile, Flint-based McLaren Regional Medical Center says the city’s contaminated water probably contributed to a January 2014 Legionnaires’ disease outbreak that occurred right after the city started drawing water from the Flint River. The hospital president says health agencies didn’t inform the public about the outbreak until just a few weeks ago, adding, “It’s a public health issue. There were people in the city of Flint seeing brown water. It would seem logical that there would have been public reporting or public awareness about the Legionella situation.”

Reader Comments

From Caveat Emptor: “Re: Epic hosting. We’re one of the first, scheduled to go live in a few months. The IT department tells us we may not be able to scan documents into Epic due to poor integration with our McKesson document management system. There is some very serious anger at Epic right now. They seem to have been caught flat-footed, which raises questions about what other third-party vendors Epic-hosted solutions can’t accommodate.” Unverified.

From Mark: “Re: CenTrak. Heard it was acquired this week.” I’ve seen no news about the RTLS vendor so far.

From InBetweener: “Re: CHIME. They will award $1 million to anyone that technically solves the national patient identifier problem (underwritten by a vendor contribution, of course). Here we have a classic political failure that needs to be solved by technology. Healthcare is full of these ‘insane’ situations and we wonder why systems overly complex, don’t work as planned, have errors, and cost a bundle? The simple albeit political solution is to allow a opt-in/out NPI, just like TSA does for trusted fliers. Works for TSA, no privacy uproar. Why not for CMS? Why isn’t HIMSS/CHIME spending a million to lobby for that solution?”

HIStalk Announcements and Requests


A slight majority of poll respondents expect CMS’s changes to the Meaningful Use program to be positive. New poll to your right or here: is an ONC-produced EHR "star rating" a good idea?

Four firms donated $1,000 each to DonorsChoose to attend my HIMSS lunch with 10 or so CIOs. I won’t recite the individual projects I funded as a result since it’s a long list, but I’ll run photos and updates from the teachers when I get them (most of them emailed me their thanks over the snowy weekend). Nearly everything I funded was STEM related – iPad Minis, programmable robots, Chromebooks, math manipulatives, headphones, and science activity kits. Thanks to these companies for helping teachers and students in need.


Consulting firm Optimum Healthcare IT made a second $1,000 donation following its first one last week.


Serra Health Consulting donated $1,000.


Electronic forms and workflow vendor FormFast provided $1,000, which funded six great projects.


Nordic, which always steps up to support HIStalk, donated $1,000 to fund projects that include two I chose specifically from teachers in their home state of Wisconsin.


Our budget-minded HIMSS Booth #5069 will by necessity be microscopic, remote, and amateurishly furnished. However, it always overflows with more enthusiastic, fun visitors than those block-spanning monolithic monuments to executive egos. Contact Lorre if you are an industry celebrity (loosely defined) and want to hang out for an hour with her saying hello to readers. I’m hoping she can get Martin Shkreli to sign up. 

We give out “secret crush” beauty queen sashes on stage each year at HIStalkapalooza for whoever submits the most convincing reason they deserve one. I’ve ordered ones indicating Mr. H, Jenn, Lorre, and Dr. Jayne if you want to send your entry to me. My main lesson learned from years of planning the event – other than that people vastly prefer an open bar to drink tickets — is that nearly everyone likes wearing a beauty queen sash.


Mrs. Twigg from Missouri says the document camera we provided in funding her DonorsChoose grant request has changed her classroom’s dynamic since students can now see everything up close and are able to demonstrate their own work to the class. She says, “There are a few students who are soft-spoken and a little uncomfortable speaking in front of their peers. The document camera has been especially beneficial for these students because the focus is more towards their work, and less on them individually … I have noticed that the document camera has greatly enhanced their oral communication skills …It’s nearly impossible to imagine our classroom without the document camera because it has created endless opportunities for each student and their learning experience as a fourth grader. On behalf of every fourth grader who walks through room 205, thank you.” That’s a really impressive result from our donation of just $100 (I applied matching funds from the Ewing Marion Kauffman Foundation).


Also checking in is Mrs. C, who says her Texas second graders love using the iPad Mini keyboards and styli we provided.

Here’s an old but funny video of a sketch from Britcom “That Mitchell and Web Look” called “Homeopathic A&E” that amused me when I ran across it this week.

image image

I’m fascinated by the war that’s heating up between ad-serving websites and their readers. Internet users started it by using ad-blocking software that threatens the sole revenue stream of most online publishers in squelching their increasingly intrusive expanding banner ads, pop-up banners, and obnoxious auto-play video commercials. Some of those sites in turn starting blocking access unless the ad-blockers are turned off. Google gets most of its revenue from displaying ads and thus is obviously not a fan of ad blockers (and in fact prevents Android users from installing them), but just announced that it suppresses some of the more annoying or misleading ads, apparently hoping to convince people they don’t need ad-blocking software that it can’t control. One ad-blocker vendor just accused a big competitor of accepting company bribes to let their ads through its filter, while Firefox creator Mozilla just released a new browser (Brave) that blocks publisher ads but instead inserts its own. I’ve noticed that quite a few sites won’t even load on my tablet due to the mess of advertising junk that’s trying to load in the background or pop up intrusively in ways that don’t work on tablets.

Here’s when hospitals will see the impact of this weekend’s blizzard: early November, in their L&D departments.


HIStalkapalooza Sponsor Profile – Forward Health Group


Forward Health Group to unBooth at HIMSS16! A visual extravaganza is rolling into booth #2477. FHG, a leader in value-based population health management solutions, zigs when everyone else zags. The fast-growing company will feature prodigious, on-the-fly artistic talents, generating marvelously whimsical graphic population health management collaborations with HIMSS visitors. Producing giant eight-foot, hand-drawn murals each day, recording booth visitors’ visions of their value-based population health futures, FHG will also provide demonstrations of five new PopulationManager products, including innovative pre-packaged FastForward PopulationManager solutions for chronic care, acute episodes, behavioral health, bundled payments, and national standards reporting. Fresh oranges, too. A splendid time is guaranteed for all.

Last Week’s Most Interesting News

  • Titus Regional Medical Center (TX) remains without its EHR several days after its servers are hit with ransomware.
  • The Senate’s HELP committee releases draft legislation that it will consider on February 9 that includes streamlining government EHR requirements, charging ONC with publishing an EHR star rating system, increasing interoperability efforts, and creating an ONC-led committee to drive creation of a national health IT infrastructure that includes accurate patient identification.
  • An investigative report finds that Practice Fusion originally expected to go public next year with a valuation of $1.5 billion, but plans and expectations have changed with the decline in the stock market.
  • Leidos is rumored to be close to taking over Lockheed Martin’s IT and services businesses.
  • UnitedHealth Group announces that it lost $720 million selling insurance plans on the exchanges in the fiscal year and expects losses to continue, but reports stellar performance from its Optum services business.
  • OCR clarifies the provider requirements for giving patients copies of their medical information, suggesting that it will step up its enforcement efforts.


None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Cloud and managed services vendor TierPoint acquires Midwest competitor Cosentry, expanding its operations to 38 data centers.


Pre-launch digital medicine vendor Akili raises $30.5 million to continue development of its video game-like cognitive disorder diagnosis and treatment apps.



Hearst Health promotes Kevin Daly to president of its Zynx Health business.

Announcements and Implementations


Athenahealth customer University of Toledo Medical Center (OH) will help the company develop inpatient capabilities based on its acquired RazorInsights and WebOMR systems, which will be retooled to create an AthenaNet cloud-based hospital system. I’m not certain which systems UTMC uses, but I think it’s McKesson for both ambulatory (HAC) and inpatient (the ancient McKesson Star).

Government and Politics


I finally heard back from the Office for Civil Rights about the complaint I filed in July 2015 against a large, Epic-using, EMRAM Stage 7 academic medical center that refused to give me an electronic copy of my medical records (they told me, “We only do that for doctors.”) The letter acknowledges the hospital’s responsibility to give me what I requested, but concludes with, “We have determined to resolve this matter informally through the provision of technical assistance to the hospital,” thus closing my complaint. I still don’t have an electronic copy of my information seven months after requesting it and the hospital will apparently see no repercussions for refusing to provide it. OCR’s insistence last week that it will zealously protect patient rights to receive their own medical information seems to be bureaucratic chest-thumping rather than a commitment to actually meting out punishment for intentional non-compliance, at least from this N of one.

Privacy and Security

A patient of an Indianapolis hospital complains about receiving calls demanding that she make payments on her pacemaker, apparently originating from a con artist spoofing the hospital’s caller ID.

A Utah women is arrested for entering narcotics prescriptions for herself by logging as a doctor into an old computer at the Intermountain clinic where she previously worked as an administrative assistant. She wrote 260 prescriptions for 62,000 doses for which insurance paid $26,000. At an average of nearly 250 pills per prescription, you would think the pharmacy might have become suspicious.


A Scripps Translational Science Institute study finds that smartphone-powered biosensor monitoring did not improve outcomes for patients with hypertension, diabetes, or arrhythmias. The study’s methodology was decent although it used data from 2012.

Nabil El Sanadi, MD, president and CEO of Broward Health (FL), commits suicide. 


A 54-bed hospital in rural Georgia that hired a local car dealer as its turnaround CEO faces closure again after paying big money to the CEO and experts he brought in. The CEO was paid $480,000 per year on contract (quadruple the pay of his predecessor) with checks made out directly to his Ford dealership. He paid millions to bring in employees and contractors with connections to Duke University, where he had studied, including a reported $458,000 over five years for the CIO. Employees claim his hired gun experts were driven by data rather than patient needs. The hospital faces closure if the locals don’t approve a tax increase.


An editorial in NEJM warns of “research parasites” who “use another group’s data for their own ends” and who might not understand the differences in multiple datasets that they combine. It recommends that researchers start with an original idea rather than a me-too concept and then find collaborators with whom to share data, work together to create new hypotheses, and jointly publish their findings. I can’t decide if this is sound thinking or egotistical data-hoarding by academics more interested in furthering their careers than making patient-contributed datasets available for the public good.

Weird News Andy says this doctor was uber-rude. A fourth-year neurology resident at Jackson Health System (FL) is suspended pending an investigation after a video of her attacking an Uber driver goes viral with several million views. The apparently intoxicated doctor hopped into an Uber car that someone else had called, refused to get out, beat the driver, and threw all of his belongings into the street while cursing at him. Police responded but filed no charges after she told them (while crying) that she would lose her medical license if arrested.

Sponsor Updates

  • T-System and VitalWare will exhibit at the HFMA Region 11 Healthcare Symposium January 24-29 in San Diego.
  • Wolters Kluwer Health publishes an e-book titled Integrated Clinical Decision Support: Accelerating Adoption of Evidence-Based Care for Optimal Outcomes.
  • Valence Health will exhibit at the HFMA Tri-State Institute January 27-29 in Memphis, TN.
  • ZeOmega will exhibit at the Strategic Analytics for Population Health event January 25-26 in Orlando.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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Currently there are "14 comments" on this Article:

  1. Confused at why Hurley was targeted. They were the ones – led by Dr Hanna- to bring this to light. That hospital has a very high Medicaid and charity care burden and does gods work. Not sure why they were targeted- at all

  2. Re: The hacker group Anonymous is presumed to be behind a cyberattack against Flint, MI-based Hurley Medical Center, with the group apparently following through on its threats from the previous day to take action against those involved in the city’s water crisis. The hospital says its IT team detected the attack and reports no impact on operations.

    Not sure why Anonymous would cyberattack the hospital that helped bring the news of increased lead poisoning in children. It was Dr. Mona Hanna-Attisha whose data showed a sharp rise in lead poisoning in children following a change in the city’s water supply.

  3. Re: Epic Hosting – there is often more to the story. Vendors are notoriously slow in negotiations with each other to allow hosting in another’s data center. Cerner, Allscripts and McKesson have run into this in the past. Exposing one’s intellectual property is always a concern.

  4. Have to agree with inbetweener…
    National Patient ID will:
    1. Never happen with a million dollar prize What if they used partially an idea from one then another? Simply just won’t work.Needs leadership answer.
    2. Absolutely should be a voluntary ID similar to trusted fliers. Those that get the ID may get discounts on insurance due to efficiencies. If you don’t want those, then fine don’t sign up.
    3. Needs a VERY robust security/support system that has real people helping real people that get ID’s stolen, misdiagnoses propagated, etc. Not the typical DMV type help.

    So, in reality, this ID should have been solved before ANY thoughts of interoperability. Database programming 101. But now, I really think it has very little chance of ever happening and we are doomed with a terribly expensive, complicated, error prone system.

  5. The Epic hosting guys don’t want to load McKesson software on their Citrix Cloud complex. They’ve offered to do a straightforward integration with McKesson on a server to server basis as they have it operational at many other sites.

    This does point to a new future for Cloud Based systems, where software from McKesson can be hosted by McKesson and still talk to software in the Cloud from Epic.

    It doesn’t make sense to load another vendors software on a willy nilly basis.

  6. You opined that this past weekend’s winter storm will impact hospital L&D’s next November. That may be true as that was opined last year from similar weather and the release of the movie, “Fifty Shades of Gray”.

  7. I suspect that many of you reading this do not support a single payer system, but I have to wonder what becomes of “interoperability” if/when this becomes a reality? I would love a broader conversation on the impacts you anticipate from your perspectives on this topic…

  8. Disappointing to see the response from OCR, especially after all the public statements they have made as of late. Even CMS’s Slavitt went on record, again, at JP Morgan, that they will not tolerate information blocking and that citizens will have unfettered access to their records.

    Once again, as they say in TX: All hat, no cattle.

    Even sadder, most in the US don’t even know they have this right to their records and healthcare systems will go blithely along knowing that no one will truly challenge them.

  9. In response to InBetweener

    IMO there are some fundamental differences between a frequent flyer with a TSA pre-check ID and a patient opt-in, voluntary ID.
    1) A pre-check number is not used for data exchange (aka “interoperability’). It is used to assert a certain level of knowledge about the flyer. The airline and the TSA have an interface with one another and if there is a mismatch on the traveler’s demographics (name spelling, DOB) then the identity match doesn’t work, the pre-check status doesn’t work and the traveler has to get this mis-match fixed with their airline before going through security. Airlines do not exchange the travelers pre-check ID with one another as a means to universally ID the traveler…they use their own combination of FF#’s, ticket/reservation numbers and the traveler’s credit card# to identify the traveler.
    2) To compare pre-check to a similar patient identifier scheme would mean that each patient would pay some TSA-like organization a fee to do basic credentialing and to provide the patient with a national healthcare “pre-check” ID number. For every appointment or visit the patient would provide this healthcare pre-check number to his provider. This would assure the provider that this patient had achieved a basic level of credentialing (wasn’t a known fraudster at that point in time) but it wouldn’t assure the provider that the patient still lived at that home address or that they still had the same health insurance or that they hadn’t procured this number from a black-market scheme or in some way hacked the pre-check process. There is no such thing as not providing health services to a person who needs them unlike a no-fly list. So even if the healthcare pre-check number didn’t check out, the provider would most likely still render services (albeit on a cash basis!)
    3) Another difference is that travelers have some incentive to use their pre check travel number…it allows them to bypass longer security lines and to go through security without having to take off their shoes or take their laptops out of their bag. What would be the observable incentive for the patient? The TSA doesn’t pre-populate your reservation form with your identity details…as a traveler you must still complete the reservation form and the only way to pre-populate the form is to already have a frequent flyer profile with that airlines. In other words it is the combination of your FF details plus the TSA pre-check number that in combination provides an enhanced level of service. To make an equal comparison this would mean that a patient would need to know and provide their MRN# for that particular provider and would supply this in combination with their healthcare “pre-check” ID when making an appointment and checking in. And after all of that the provider would still need to make sure that the patient’s demographic and insurance details as of today were correct.

    TSA pre-check and a national opt-in patient identifier are not a 1:1 comparison.

    Identity and interoperability are complimentary but not the same thing. You need one to do the other well. The missing piece here is the lack of standards around method of identification and standards for enabling interoperability.

  10. I’m confused. Did Anonymous take credit for the attack on Hurley? That is their MO — they always announce that they’ve attacked an organization.

    I think it is much more likely that Gov Snyder’s office, or another political operative who is vulnerable because of the botched water change and cover-up, is behind the attack.

  11. Regarding prior comments on Epic: I think the commenters are missing the point. It probably is commonly a slow process to get agreements with other competitors when setting up a hosting solution. If Epic is offering to do a server to server integration with whomever is reporting this, that’s great.

    But how slow is slow? When ex-colleagues of mine still at Epic told me hosting was coming down the line it was at least a couple years ago. This customer says a golive several months in the future might not be able to scan documents when they do golive. So it sounds like either years went by where this wasn’t even considered, or if it was discovered and in process then Epic can’t react in anything that sounds like reasonable time. Neither is a very comforting prospect from the customer point of view, particularly this customer that probably will delay golive on account of this.

    And the real weight of the comment is still outstanding: What other integration points were not considered?

  12. In response to InBetweener: I have little confidence that the CHIME challenge will get us to where we need to be on this contentious issue. But check out http://www.gpii.info. It’s a NON-PROFIT, OPEN, STANDARDS-BASED solution that includes opt in/opt out (although I remain skeptical that most patients can make a well-informed decision about this) and there is NO PHI in a central data base. Really. This has been presented to a number of health IT vendors, ONC, and others but no one has quite understood the simplicity of this (virtually) free solution.

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